Outcomes of Multidetector Computed Tomography Pulmonary Angiography in Pregnant and Postpartum Women With Suspected Pulmonary Embolism

2020 ◽  
pp. 084653711989955
Author(s):  
Simon Sun ◽  
Marius Diaconescu ◽  
Tian Zhe ◽  
Benoit Mesurolle ◽  
Alexandre Semionov
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Odds Ratio ◽  
Pulmonary Angiography ◽  
Reproductive Age ◽  
P Value ◽  
Postpartum Women ◽  
Computed Tomography Pulmonary Angiography ◽  
Early Postpartum ◽  
Independent Risk Factors

Purpose: Verify whether there is a difference in likelihood of developing pulmonary embolism (PE) between pregnant women, nonpregnant women of reproductive age, and postpartum (up to 6 weeks) women, by comparing their outcomes on computed tomography pulmonary angiography (CTPA) done for suspicion of PE. Materials and Methods: Retrospective cohort study of 1463 CTPA done for suspicion of PE in females of reproductive age (18-40 years), nonpregnant, pregnant (antepartum), and postpartum, from 2 tertiary-care academic hospitals between October 2006 and September 2015. Primary outcome was diagnosis of PE on imaging. Additional assessment was made of technical adequacy of the studies and method of delivery for the postpartum cohort (vaginal vs caesarean birth). Twenty-nine technically nondiagnostic studies were excluded. The effect of any potential variable on PE status was tested using univariate logistic regression. Subgroup analysis was performed after excluding patients with independent risk factors for PE. Results: The rate of CTPA positive for PE was less among pregnant patients compared to early postpartum and nonpregnant women of similar age, 2.9% vs 11.5% and 10.3%, respectively. Pregnancy was associated with statistically significant decreased odds ratio of developing a PE on CTPA, 0.23 (0.09-0.89), P value = .004. After excluding patients with additional independent risk factors for PE, there was no statistically significant odds ratio association between presence of PE on CTPA and pregnancy 0.41 (0.13-1.34), P value = .14. Conclusion: Rate of CTPA positive for PE in pregnant women was lower than in nonpregnant and early postpartum women. Pregnancy was statistically significantly less likely to be associated with positive PE on a CTPA study. The common perception that pregnancy (antepartum state) is associated with an increased risk of PE may require a thorough critical reappraisal.

scholarly journals A study in a teritary centre for clinical assessment of pelvic inflammatory disease risk among women attending outpatient department

2017 ◽  
Vol 6 (9) ◽  
pp. 3823
Author(s):  
Sowmya D. ◽  
Sowjanya D.
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Pelvic Inflammatory Disease ◽  
Birth Control ◽  
Inflammatory Disease ◽  
Odds Ratio ◽  
Vaginal Discharge ◽  
Reproductive Age ◽  
P Value ◽  
Factors Associated

Background: Pelvic inflammatory disease (PID) is associated with major medical and economic consequences for women of reproductive age. Identification of the risk factors associated with PID is crucial to efforts for prevention of these consequences. This study is done to evaluate the risk factors for PID in women attending OPD at Gangori hospital.Methods: This Study is an observational study, Conducted in Department of Obstetrics and Gynecology, Gangori hospital, SMS Medical College, Jaipur, From January 2015 to June 2015. Risk factors of PID were assessed in 70 women with PID (study group) and then it was compared with 70 controls attending the Women's Clinic at the same institution. Significance of difference in proportion in various variables of PID in both the group was inferred by odd’s ratio and Chi-square test. Logistic regression analysis was used to adjust for confounding variables.Results: A total of 70 women with PID and an equal number of controls were included. Cases were significantly younger than controls (p<0.001). The women were mainly of lower socioeconomic status. Risk factors identified by bivariate analysis were less than secondary level education, Odds ratio [OR] 5.29; (95% confidence interval: 1.680 to 16.675) P value 0.005. Parity >0, Odds ratio 2.521 (95% CI: 1.140 to 5.577) P value 0.033. Spontaneous abortion >0, Odds ratio 3.11 (95% CI: 1.311 to 7.362) P value 0.015. Lack of a birth control method, Odds ratio 7.18 (95% confidence interval: 3.091 to 16.662) p value<0.001. younger than 18 years at age of first sex, Odds ratio 2.84 (95% CI: 1.404 to 5.753) P value 0.006. Sex during the previous menses Odds ratio 5.39 (95% CI: 2.317 to 12.529) P value <0.001. Vaginal discharge/bleeding, Odds ratio 5.84 (confidence interval 2.717 to 12.578) P value <0.001. With multivariate analysis to control for confounders the risks still identified were sex during the previous menses, parity >0, lack of contraception, vaginal discharge and age at first sex.Conclusions: Identification of the risk factors associated with PID is most important effort for prevention of the disease and its sequelae. Educating the women, encouraging the use of condoms and other methods of contraception for PID prevention, sexually transmitted disease prevention and also birth control. Another finding is that, it is better to avoid coitus during the menses.

Spectral Detector Computed Tomography Pulmonary Angiography

2018 ◽  
Vol 42 (6) ◽  
pp. 850-857 ◽  
Author(s):  
Nils Große Hokamp ◽  
Rivka Kessner ◽  
Steven Van Hedent ◽  
Frank Philipp Graner ◽  
Amit Gupta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography

scholarly journals Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

2020 ◽  
Author(s):  
Ruo-Yi Huang ◽  
Szu-Jen Chen ◽  
Yen-Chang Hsiao ◽  
Ling-Wei Kuo ◽  
Chien-Hung Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endotracheal Tube ◽  
Odds Ratio ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Shortness Of Breath ◽  
Airway Protection ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Facial Burn

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

scholarly journals Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

2020 ◽  
Vol 73 (6) ◽  
pp. 542-549
Author(s):  
Taeha Ryu ◽  
Baek Jin Kim ◽  
Seong Jun Woo ◽  
So Young Lee ◽  
Jung A Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Odds Ratio ◽  
Arthroscopic Surgery ◽  
Sitting Position ◽  
Past Medical History ◽  
Frequent Adverse Event ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Independent Risk Factors

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

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